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General NPI Number Information
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NPI Number | 1932804713
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Entity Type | Individual
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Provider Name | JUDE DANTE
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Gender | Male
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 6363 WILSHIRE BLVD STE 516
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City | LOS ANGELES
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State | CA
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Zip | 90048-5726
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Country | US
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Telephone | 561-543-3096
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Fax |
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Provider Business Mailing Address
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Address Line | 4904 MESSANA TER
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City | LAKE WORTH
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State | FL
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Zip | 33463-7291
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Country | US
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Telephone | 561-543-3096
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 9541-PA-C
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9541-PA-C
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9541-PA-C
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License Number State | AZ
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